Posts Tagged ‘Department of Health and Human Services’

CMS Issues Revised Guidelines for Electronic Medical Records Adoption

Thursday, July 29th, 2010

Physicians/hospitals could receive $27 billion to use electronic medical records.  The federal government has issued revised standards for the “meaningful use” of electronic medical records that will financially reward physicians and hospitals who adopt the new technology. According to the Department of Health and Human Services, physicians and hospitals could receive as much as $27 billion over the next decade if they put patients’ medical records on computer instead of paper.  Physicians can be paid up to $44,000 under Medicare and $63,750 for Medicaid.  Depending on their size, hospitals have the potential to receive millions of dollars.  In 2015, hospitals and physicians face financial penalties under Medicare if they fail to use electronic medical records by the deadline.

Dr. Donald Berwick, the new administrator of the Centers for Medicare and Medicaid Services (CMS) said electronic medical records will lead to “better, smoother care, more reliable care.”  Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said “Only 20 percent of doctors and 10 percent of hospitals use even basic electronic health records.”  Taking a slightly different perspective, Richard J. Umbdenstock, president of the American Hospital Association (AHA), said the new standards are an improvement over the rules initially proposed but was not convinced that doctors or hospitals would adopt the new technology.

Some physicians believe that using electronic medical records will reduce errors and save patients’ lives.  The new standards are flexible and require physicians to meet 15 specific requirements, as well as another five selected from a list of 10 objectives.  To fulfill the new standards, physicians will have to submit 40 percent of prescriptions electronically.  “We are delaying some of the more ambitious requirements,” said Dr. David Blumenthal, the national coordinator for health information technology.

HealthCare.gov Debuts on a Computer Near You

Tuesday, July 20th, 2010

New HHS website a source for all things healthcare reform.  The Department of Health and Human Services (HHS) has launched a new website to help Americans better understand and explore the options open to them as healthcare reform legislation takes effect.  The website was mandated in the healthcare reform bill passed in March; in October, there will be a tool that lets people compare pricing for various insurance plans.

Insurance companies aren’t entirely happy with some of the content on the new HHS website.  The industry’s lobbyist, America’s Health Insurance Plans (AHIP) told HHS that they were not comfortable about the insurance plan information that might be detailed on the website.  One of the sore spots was the government’s request for data on how many claims are denied by healthcare plans.  According to Robert Zirkelbach, an AHIP spokesman, “Providing information about claims denials without providing proper context does not begin to tell the whole story.”  Zirkelbach said that claims are often denied because of duplicates or submitting a claim to the incorrect health plan.

HHS Secretary Kathleen Sebelius, writing on the White House blog, said “The site makes a system that thrived on complication and confusion easier to understand.  This kind of transparency helps create informed consumers, which increases competition, reduces prices and improves quality.”  The website’s two-minute video explains the law and its provisions, while a tab on the home page provides in-depth information on the law.  HealthCare.gov even has its own Twitter account.

High-Risk Pool Healthcare Has Hefty Premiums

Monday, July 19th, 2010

“High-risk pool” healthcare coverage comes at a steep price.  Healthcare coverage for uninsured Americans with pre-existing conditions won’t come cheaply. Premiums in the new “high-risk” pool could average $300 to $600 a month in certain states, according to a new government website.   The Department of Health and Human Services says that the premiums could range from $140 to as much as $900 a month.

According to Richard Popper, deputy director of the Office of Consumer Information and Insurance Oversight, “There are going to be meaningful premiums that are going to be required to stay in this plan…in the hundreds of dollars.”  HealthCare.gov estimates show that monthly premiums for a 50-year-old Floridian would be $552 to $675; for a New Yorker, the average cost would be $400 to $600; $491 to $600 for a Texan; and only $283 for a Pennsylvanian.  Coverage under the Pre-Existing Condition Insurance Plan begins on August 1.

Consumer advocates are advising the uninsured who have health problems to sign up quickly - despite the cost - because they cannot be turned down for coverage.  The high-risk pool is a temporary solution for at-risk individuals who cannot get healthcare insurance because of a medical condition.  The pool will be available until 2014 when healthcare reform takes full effect.  At that point, insurance companies will not be allowed to turn down people in poor health.  Low- and middle-income individuals will receive subsidized coverage.

HHS Has $250 Million to Train Primary-Care Physicians

Monday, July 12th, 2010

Healthcare reform provides $250 million to train primary-care physicians, physician assistants and nurse practitioners.  Medical schools and teaching hospitals that educate primary-care physicians and allied professionals can apply for $250 million in new grants through the Prevention and Public Health Fund.  According to Health and Human Services (HSS) Secretary Kathleen Sebelius, the grants are 50 percent of a $500 million fund created by healthcare reform legislation. The doctor deficit goes back to the 1980s and 1990s when medical schools capped their enrollments at 16,000 students per year because they believed that managed care would create a physician glut.

With the nation facing a shortage of 66,000 primary-care physicians just 10 years from now, including 7,000 in underserved urban and rural areas, according to HHS, the new funding is welcome news and represents a starting point to resolve the physician shortage.  The money will train approximately 1,700 new primary-care physicians, physician assistants and nurse practitioners through 2015.  Representative Lois Capps (D-CA) describes the new healthcare bill as a jobs bill because it provides funding to train new healthcare professionals.

The lion’s share of the grants — $168 million - will benefit physicians and be awarded to 105 eligible teaching hospitals and university medical schools.  An additional $32 million will fund 40 programs that train physician assistants.  Another $30 million will fund nurse practitioner training.

Although the 1,700 primary-care physicians this grant money will train is a drop in the bucket - considering that approximately 250,000 active physicians are expected to retire between now and 2020 - it represents a step in the right direction.

Medicaid Kids Are Missing Crucial Health Screenings

Tuesday, July 6th, 2010

Nearly three-fourths of kids on Medicaid who live in nine states failed to undergo all required medical, vision and hearing screenings, according to a report from the Department of Health and Human Services’ Office of the Inspector General (OIG).75 percent of kids on Medicaid are missing required healthcare screenings.

After studying Medicaid children living in Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, North Dakota, Texas, Vermont and West Virginia, the OIG determined that 2.7 million - approximately 76 percent - had not had their required Medicaid Early and Periodic Screening, Diagnostic and Treatment tests (EPSDT).  Considered vital medical screenings for Medicaid recipients under the age of 21, these test overall health, vision and hearing.  Even when children did have some EPSDT screenings, 60 percent did not undergo at least one required test.

The OIG report suggested that the Center for Medicare and Medicaid Services (CMS) require states to:

  • Report the number of healthcare screenings performed on children.
  • Work in partnership with other states and providers to develop effective strategies to encourage participation in screenings.
  • Educate and incentivize Medicaid recipients about the importance of these tests.
  • Identify and provide information on how to increase participation in comprehensive medical screening.

According to CMS, the agency needs “to assess the effect that the new data-collection requirements might have on states’ financial resources.”  Additionally, it must take into account “the difficulty states might have in obtaining data on services that are provided outside traditional provider settings.”

Healthcare Bill Offers Some Financial Assistance to Educate Doctors, Nurses

Monday, June 14th, 2010

The healthcare reform bill provides some funding to educate new doctors and nurses, although the nation still faces severe staffing shortages.  “The act increases incentives for primary care and it adds maybe 300 more physicians trained per year in residency slots, which is a drop in the bucket,” said Valerie Parisi, M.D., interim dean at the Wayne State University School of Medicine in Detroit.

Approximately 16,000 new physicians graduate annually from the nation’s 130 medical schools, and subsequently enter graduate residency training at one of the 1,200 teaching hospitals.  Just 10 years from now, the nation will face a shortage of 66,000 primary-care physicians, including 7,000 in underserved urban and rural areas, according to the Department of Health and Human Services.  An additional 100,000 specialty physicians will be needed, such as geriatric specialists and pulmonologists as millions of baby boomers retire and require treatment for chronic health conditions.  At present, the nation has approximately 756,000 active physicians.  Given an estimated United States population of 309,000,000, that adds up to just one physician for every 408 persons.  The nursing profession is experiencing similar shortages.  By 2020, the nursing shortage could be between 300,000 and 1,000,000, according to the journal Health Affairs.

The Patient Protection and Affordable Care Act boosts loan repayment funding for medical and nursing students and re-authorizes nursing workforce development program, which provide federal dollars for nursing education.  To help undergraduates, the bill increases the loan amount available for nursing education from $13,000 to $17,000 at an interest rate of just five percent.  Currently, loan forgiveness tops out at $35,000 for undergraduates - providing they work in underserved areas.  The bill provides $105,000 - or $35,000 a year - for pediatricians, child mental health workers and public health professionals working in areas with limited medical resources.

Boehner Continues to Bad-Mouth Healthcare Reform

Monday, May 24th, 2010

John Boehner knocks Kathleen Sebelius letter on the virtue of healthcare reform legislation.  Although healthcare reform legislation is now the law of the land, Representative John Boehner (R-OH), the House Minority Leader, is still not shy about communicating his distaste for the bill. Recently, Boehner sent a letter to Kathleen Sebelius, Secretary of Health and Human Services, citing increased cost estimates, job-loss information and what he perceives as a lack of follow-through on an executive order regarding abortion coverage that the GOP finds troubling.

Boehner’s letter is a response to a recent statement by Secretary Sebelius, which stressed the law’s initial deliverables, including health insurance reform and tax credits available to small businesses.  “Now I’ve seen my fair share of propaganda, but this letter must have been written in an alternate universe,” Boehner said.  Republicans have uniformly opposed the healthcare bill throughout the process; the majority claim that it will increase costs.  Additionally, the GOP hopes that the healthcare law will guarantee them a majority victory over Democrats in November’s mid-term elections.  The GOP is expected to win more mid-term elections in the House versus the Senate.

Sebelius said that “Now, I want to be clear: the Affordable Care Act is not a magic pill that will cure all the problems in our health care system.  It will take time for all the benefits to kick in.  And if you look at the history of major social legislation, you see that there are always revisions and adjustments along the way.”

Speaker of the House Nancy Pelosi sides with Sebelius, saying “We’re very pleased with the unfolding of the healthcare bill,  In a bigger sense, it is about a healthier America.”

Arnold Schwarzenegger Breaks With Republicans to Support Healthcare Reform

Thursday, May 20th, 2010

Schwarzenegger breaks with Republicans to support healthcare reform.  “The Terminator” has changed his mind.  Although he originally opposed healthcare reform as the legislation moved through Congress, California Governor Arnold Schwarzenegger now fully supports the new federal law.  In a speech at the University of California at Davis Medical Center, the governor - who cannot run for re-election because of term limits — broke rank with his fellow Republicans, many of whom have announced their intention to sue the federal government to overturn the law.

“California is not part of this fight, and I’ll tell you why,” according to Schwarzenegger.  “When you don’t have health insurance and you go to the hospital, you are forcing other people to pay for your healthcare.”  Twenty percent of California residents lack healthcare insurance, a situation that Schwarzenegger says is a crisis that requires resolution.  “The bottom line is the plan is not without flaws, but it is a good law,” he said.  To fill the void, California is launching a temporary high-risk insurance pool to cover the uninsured that will be funded by $761 million in Department of Health and Human Services money through 2014.

Schwarzenegger also vowed to enforce the law, to the point of making certain that the state’s insurers comply with bans on lifetime spending caps.  If necessary, he will call the state Legislature into a special session to make statutory changes to comply with the act’s provisions.  “We’re ready to roll up our sleeves and work with the federal government to get this done,” the governor said.

“Barely Hanging On”

Tuesday, May 11th, 2010

Study finds that middle-class Americans are losing their healthcare coverage.  Middle-class Americans are losing their healthcare insurance at a faster rate than other income earners. This finding was reported in “Barely Hanging On”, prepared by the University of Minnesota’s State Health Access Data Assistance Center.  The report was commissioned by the Robert Wood Johnson Foundation as part of its yearly Cover the Uninsured Week and analyzed data from the U.S. Census Bureau and the Department of Health and Human Services.

According to the study, three million fewer middle-income Americans had healthcare insurance provided by their employers in 2008 when compared with 2000.  Two-thirds of families earning between $45,000 and $85,000 a year were insured by their employers in 2008, a seven percent drop from 2000.

The study also found that costs had risen 81 percent between 2000 and 2008.  During the same timeframe, household incomes fell 2.5 percent.  Additionally, fewer workers were offered or could afford employer-provided coverage.

“America’s uninsured crisis means that hard-working people with average incomes are being squeezed,” said Risa Lavizzo-Mourey, the Robert Wood Johnson Foundation’s president and CEO.  “The fallout from rising health insurance costs hits everyone.”

Healthcare Spending to Rise $331 Billion Over Next Decade

Thursday, May 6th, 2010

Healthcare spending to increase as reform law goes into effect.  Healthcare expenditures are likely to increase by $311 billion over the next 10 years as the reform law is implemented and more people are covered, according to the Department of Health and Human Services (HHS). HHS actuaries report that expanded coverage will lead to increased utilization of healthcare services.  That is $77 billion higher than a previous assessment of the reform bill approved by the Senate in December, when it was estimated that spending would climb by $234 billion over the next 10 years.

“Although several provisions would help to reduce healthcare cost growth, their impact would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions,” according to a report released by the Center for Medicare and Medicaid Services (CMS).  The Office of the Actuary report estimates that the ultimate impact of Medicare provisos in the legislation are expected to save $575 billion from this year through 2019.  The lion’s share of those savings will result from reductions to physician and hospital inflationary payment updates.

Republicans quickly touted the report.  According to Representative Dave Camp, (R-MI), a member of the House Ways and Means Committee, “This is a bad law and, according to this analysis, seniors have the most to be concerned about when it comes to the future of their healthcare.”